An Adult Case of Pyogenic Arthritis Occurring before THA

Abstract

We report an adult case of pyogenic arthritis of the hip. A 74-year-old woman was admitted to our hospital because of fever and increasing right hip pain. She was scheduled to undergo right total hip arthroplasty (THA) because of rheumatoid arthritis. There was no history of joint puncture or trauma. The patient’s body temperature was 38.2°C and movement of her right hip was restricted because of severe pain. The white blood cell count was 9100/μl and CRP was 13.4mg/dl. Plain radiography showed narrowing of the joint space in the right hip, and magnetic resonance imaging showed right hip effusion. One day after admission, aspiration of the right hip joint was performed, and culture of the aspirate grew α-Streptococcus. The patient therefore received intravenous antibiotics. Five days after admission, debridement, irrigation and the Girdlestone procedure were performed on the right hip. After surgery, intravenous antibiotics were continued for 10 days. The body temperature and other clinical indicators of inflammation gradually improved, and the patient was discharged 19 days after surgery. As Indium-111 scintigraphy at 5 months after surgery showed no signs of infection, THA of the right hip was performed. Six months after THA, the patient has no problems with the treated hip.
Adult cases of pyogenic arthritis without a history of joint puncture or trauma are rare. However, as the prognosis of such cases is sometimes very poor, joint puncture must be performed immediately and adequate treatment should be instituted whenever such cases are suspected.